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This evening I'm going to try and tackle the topic of facial fillers which is a really broad topic, so you have to bear with me as I kind of go through this. First, we're going to talk about the different types of fillers. Then, we're going to talk about the uses of those fillers, and we'll try and define which fillers are better for which locations.

Firstly, what are the types of facial fillers? This is a question we'll have to answer in the context of what is currently F.D.A. approved in the United States. Because there are a lot of different fillers that are used outside of the United States that eventually may gain approval here.

Actually, I probably will leave out some fillers that are available in the United States just because there are certain ones that I don't really feel fill a niche outside of what we already use other fillers for. So, I may not mention some of those.

The main filler classes are hyaluronic acid fillers which consist of Juvederm, Juvederm Ultra, Restylane, and Perlane. There may be some other hyaluronic acid ones out there. There was Hylaform and Captique, and I think maybe some of those are still around out there but they're not commonly used.

There are also porcine, which is pig collagen, fillers out there. I believe the most common one is called Evolence. It's another filler that's available. You may have heard about it. You may see ads about it. I personally don't see a role for that in conjunction with what the hyaluronic acid fillers do, so we haven't really used that filler.

There's also the calcium hydroxyapatite class of which the one that's approved in the United States is referred to as Radiesse.

There was a permanent filler on the market in the United States referred to as Artefill. The company that held that went bankrupt. It's now been re-released by a new company. It is a permanent filler that consists of bovine, or cow collagen, mixed with polymethyl methacrylate beads which is a permanent filler.

Then, there's liquid silicone which is F.D.A. approved for ophthalmologic use, and some physicians are using it as a permanent filler. It is not something that I recommend. I think that if it is done properly you can get benefit that is safe from it.

The problem with it is that it can persist, or will persist, for years, but can persist in growing collagen around it for years and may end up with results 20 years down the road that are not what was intended at all. Therefore, we do not do liquid silicone in our office, and I don't particularly advocate its use.

Let's talk a little bit more about those fillers and those classes. Hyaluronic acid fillers are a big mucopolysaccharide molecule, basically a big sugar molecule. It's a naturally produced substance in the body. It's present in skin. It's present in joint fluid. It's present in the vitreous of the eye.

It has basically been taken as that molecule and produced in a test tube. The ones that we most commonly use - Juvederm, and Restylane, and Perlane - are produced through a process of bacterial fermentation to produce the molecule which then undergoes a cross linking process. If you just take the native hyaluronic acid molecule as it is in the body and inject it it only has a longevity of a day or two. So, these products are cross linked through a molecular process so that the molecules become bigger, are harder to break down, and therefore last longer.

In general, the hyaluronic acid molecules, when injected, last somewhere between six months to a year or slightly longer depending upon where you inject them. The more mobile part of the face you inject them into the least longevity they have. The more stable the area you inject them the longer longevity they have.

The lips are the shortest longevity, and under the eyes or in the glabella or frown line area tend to be the longest area of longevity. So, somewhere between six months and a year, and the most average is probably about nine months for the hyaluronic acid fillers.

For the calcium hydroxyapatite fillers this is, again, that molecule. It's calcium hydroxyapatite. The most common one is Radiesse. What that molecule is is a molecule that is the precursor to what forms bone in the body. It needs to undergo another chemical process to make bone. So, when you inject it in the soft tissues you're not going to get bone out of it.

But, when produced in the test tube it forms a nice pasty material that has good longevity, good feel, good support, but eventually, again, is broken down by the body into calcium and phosphate molecules which are naturally occurring in the body and can't harm you in any way. It resorbs over time. So, again, it's not a permanent filler. It's a semi-permanent filler and may produce some collagen production after injection in the body that may be a permanent benefit to that, although it won't give you the same degree of gross correction as the filler when it's in place will do.

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Hyaluronic Facial Fillers

Dr. Edward Buckingham discusses the different types of FDA approved facial fillers, including Juvederm, Restylane and Perlane.